Healthcare Provider Details

I. General information

NPI: 1801450069
Provider Name (Legal Business Name): ZI LEI JEREEN KWONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE STE 436
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

1338 BING DR
SAN JOSE CA
95129-4701
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-8387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: